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Who is responsible for obtaining prior authorization? The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.
Special Authorization and Prior Authorization are interchangeable terms we use to describe a pre-approval process that helps us determine if certain prescription drugs will be reimbursed under your benefit plan. Most drugs that require prior authorization are considered high-cost specialty drugs.
Prior authorization works like this: Step 1: If your doctor didn't contact your insurance company when prescribing a medication, your pharmacy will contact them. ... Step 2: The physician (or their staff) will contact the insurance company. ... Step 3: Your insurance provider may want you to fill out and sign some forms.
How to Write a Prescription in 4 Parts Patient's name and another identifier, usually date of birth. Medication and strength, amount to be taken, route by which it is to be taken, and frequency. Amount to be given at the pharmacy and number of refills. Signature and physician identifiers like NPI or DEA numbers.
The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider. As mentioned in the ?How does prior authorization work?? section above, this will then often prompt a time-consuming back and forth between the provider and payer.